<div class="row">
	<div class="col-sm-6">
		<section class="panel">
			<header class="bg-success panel-heading font-bold">Biodata</header>
			<div class="panel-body">
				<form class="form-horizontal" method="get">
					<div class="form-group">
						<label class="col-sm-4 control-label">Nama lengkap</label>
						<div class="col-sm-7">
							<input type="text" class="form-control" data-required="true" value="anif bahwal" disabled>
						</div>
					</div>
					<div class="line line-dashed line-lg pull-in"></div>
					<div class="form-group">
						<label class="col-sm-4 control-label">Tempat lahir</label>
					<div class="col-sm-7">
						<input type="text" class="form-control" data-required="true" value="Surabaya" disabled>
					</div>
					</div>
					<div class="line line-dashed line-lg pull-in"></div>
					<div class="form-group">
						<label class="col-sm-4 control-label">Tanggal lahir</label>
						<div class="col-sm-7">
							<input class="datepicker-input form-control" data-required="true" type="text" data-date-format="dd-mm-yyyy" value="12-12-2012" disabled>
						</div>
					</div>
					<div class="line line-dashed line-lg pull-in"></div>
					<div class="form-group">
						<label class="col-sm-4 control-label">Jenis kelamin</label>
						<div class="col-sm-7">
							<input type="text" class="form-control" data-required="true" value="Laki-laki" disabled>
						</div>
					</div>
					<div class="line line-dashed line-lg pull-in"></div>
						<div class="form-group">
						<label class="col-sm-4 control-label">Alamat</label>
						<div class="col-sm-7">
							<input type="text" class="form-control" data-required="true" value="Jl. Ketapang Proten " disabled>
						</div>
					</div>
					<div class="line line-dashed line-lg pull-in"></div>
					<div class="form-group">
						<label class="col-sm-4 control-label">Nomor telepon</label>
						<div class="col-sm-7">
							<input type="text" class="form-control" data-required="true" value="031123456" disabled>
						</div>
					</div>
					<div class="line line-dashed line-lg pull-in"></div>
					<div class="form-group">
						<label class="col-sm-4 control-label">Nomor handphone</label>
						<div class="col-sm-7">
							<input type="text" class="form-control" data-required="true"value="1234567890" disabled>
						</div>
					</div>
					<div class="line line-dashed line-lg pull-in"></div>
					<div class="form-group">
						<div class="col-sm-11 control-label">
							<a class="btn btn-success" target="_blank" href="<?php echo base_url('images/ktp/ktp.jpg');?>"><i class="fa fa-file text"></i><span class="text"> KTP</span></a>
						</div>
					</div>	
				</form>
			</div>
		</section>	
	</div>
	<div class="col-sm-6">
		<section class="panel">
			<header class="bg-success panel-heading font-bold">Permohonan Legalisir</header>
			<div class="panel-body">
				<form class="form-horizontal" method="get">
					<div class="form-group">
						<label class="col-sm-4 control-label">Tanggal permohonan</label>
						<div class="col-sm-7">
							<input class="form-control" data-required="true" type="text" data-date-format="dd-mm-yyyy" value="12-12-2012" disabled>
						</div>
					</div>
					<div class="line line-dashed line-lg pull-in"></div>
					<div class="form-group">
						<label class="col-sm-4 control-label">Nama SD/PAKET A</label>
						<div class="col-sm-7">
							<input type="text" class="form-control" data-required="true"value="SD ABCDEF" disabled>
						</div>
					</div>							
					<div class="form-group">
						<label class="col-sm-4 control-label">Jumlah legalisir</label>
						<div class="col-sm-3">
							<input type="text" class="form-control" data-required="true" value="3 lembar" disabled>
						</div>
						<div class="col-sm-4">
							<a class="btn btn-success" target="_blank" href="<?php echo base_url('images/ijazah/ijazah.jpg');?>"><i class="fa fa-file text"></i><span class="text"> Ijazah</span></a>
						</div>							
					</div>
					<div class="line line-dashed line-lg pull-in"></div>
					<div class="form-group">
						<label class="col-sm-4 control-label">Nama SMP/PAKET B</label>
						<div class="col-sm-7">
							<input type="text" class="form-control" data-required="true"value="SMP ABCDEF" disabled>
						</div>
					</div>												
					<div class="form-group">
						<label class="col-sm-4 control-label">Jumlah legalisir</label>
						<div class="col-sm-3">
							<input type="text" class="form-control" data-required="true" value="5 lembar" disabled>
						</div>
						<div class="col-sm-4">
							<a class="btn btn-success" target="_blank" href="<?php echo base_url('images/ijazah/ijazah.jpg');?>"><i class="fa fa-file text"></i><span class="text"> Ijazah</span></a>
						</div>							
					</div>
					<div class="line line-dashed line-lg pull-in"></div>
					<div class="form-group">
						<label class="col-sm-4 control-label">Nama SMA/PAKET C</label>
						<div class="col-sm-7">
							<input type="text" class="form-control" data-required="true"value="SMA ABCDEF" disabled>
						</div>
					</div>												
					<div class="form-group">
						<label class="col-sm-4 control-label">Jumlah legalisir</label>
						<div class="col-sm-3">
							<input type="text" class="form-control" data-required="true" value="10 lembar" disabled>
						</div>
						<div class="col-sm-4">
							<a class="btn btn-success" target="_blank" href="<?php echo base_url('images/ijazah/ijazah.jpg');?>"><i class="fa fa-file text"></i><span class="text"> Ijazah</span></a>
						</div>							
					</div>
					<div class="line line-dashed line-lg pull-in"></div>
					<div class="form-group">
						<label class="col-sm-4 control-label">Alasan pengajuan</label>
						<div class="col-sm-7">
							<textarea class="form-control" rows="3" data-minwords="6" data-required="true" placeholder="Type your message" disabled>Untuk pengurusan jabatan</textarea>
						</div>
					</div>
					<div class="line line-dashed line-lg pull-in"></div>
					<div class="form-group">
						<label class="col-sm-4 control-label">Penanda tangan</label>
						<div class="col-sm-7">
							<input type="text" class="form-control" data-required="true" value="Kepala Dinas" disabled>
						</div>
					</div>
					<div class="line line-dashed line-lg pull-in"></div>
					<div class="form-group">
						<label class="col-sm-4 control-label">Status</label>
						<div class="col-sm-7">
							<input type="text" class="form-control" data-required="true" value="Proses pengajuan" disabled>
						</div>
					</div>
					<div class="form-group">	
						<label class="col-sm-4 control-label"></label>
						<div class="col-sm-7">
							<div class="doc-buttons">
								<a href="<?php echo site_url('admin/adlegalisir/persetujuan');?>" class="btn btn-sm btn-warning btn-rounded"><i class="fa fa-print text"></i><span class="text"> Cetak</span></a>								
							</div>
						</div>				
					</div>					
					<div class="form-group">			
						<div class="col-lg-11 control-label">
							<div class="doc-buttons">
								<a href="<?php echo site_url('admin/adlegalisir/pencarian');?>" class="btn btn-sm btn-info"><i class="fa fa-arrow-circle-left text"></i><span class="text"> Kembali</span></a>
							</div>
						</div>				
					</div>					
				</form>
			</div>
		</section>	
	</div>
</div>

